ABSTRACT
Substance use and abuse are common in adolescents, and the adolescent psychiatrist should be competent and comfortable in assessing these conditions and managing their treatment. Psychiatrists can play a variety of roles in this area, and need to think carefully about the demands of their specific role as administrator, gatekeeper, case manager, psychotherapist, and/or psychophar-macologist. A thorough initial assessment is crucial, and needs to cover the extent and severity of substance use, the presence of comorbidities, the patient's medical status, and the role of the family. The clinician needs to balance his or her desire to take a history from the teen's parents with the need to establish a therapeutic alliance directly with the teen. Treatment planning should proceed with careful thought given to the proper combination of treatment modalities recommended. The psychiatrist frequently will need to coordinate care with any nonpsychiatric clinicians involved with treatment. Treatment needs may shift over time, and the psychiatrist must be alert to this possibility, and will need to adjust the treatment plan accordingly. The psychiatrist should remember that treatment of substance abuse disorders (SUDs) frequently is protracted, and must have limited and focused expectations at any moment in the arc of treatment.
